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Purpose: To report the efficacy and safety of bleb-independent penetrating canaloplasty in the management of primary angle-closure glaucoma (PACG). Methods: This single-centre prospective interventional case series enrolled 57 eyes from 53 PACG patients with medically uncontrolled intraocular pressure (IOP) and peripheral anterior synechiae of over 270°. Penetrating canaloplasty, mainly consisted of tensioning suture-aided Schlemm's canal dilation and a trabeculectomy, was performed to create a direct communication between the anterior chamber and the Schlemm's canal. Postoperative IOP, number of glaucoma medications and procedure-related complications were evaluated. Rate of success was defined as IOP ≤ 21, ≤18 and ≤15 mmHg, and a ≥30% IOP reduction without (complete) or with/without (qualified) IOP-lowering medications. Results: A total of 45 eyes had 360°catheterization successfully completed. The mean preoperative IOP was 33.9 AE 11.7 mmHg (range, 13-59.6 mmHg), on 3.2 AE 0.8 glaucoma medications (range 2-5), which was decreased to 15.4 AE 3.7 mmHg (range, 8.6-22.5) and 0.2 AE 0.6 (range, 0-3) medications at 6 months and 14.8 AE 3.5 mmHg (range, 9-24) and 0.1 AE 0.3 (range, 0-1) medications at 12 months postoperatively. Complete success at 12 months were achieved in 78.9% (95% CI: 0.65-0.93), 71.1% (0.56-0.86) and 50.0% (0.33-0.67) eyes at IOP ≤ 21, ≤18 and ≤15 mmHg, respectively. Transient IOP elevation (>30 mmHg, 26.7%) and hyphema (11.1%) were the most common early surgical complications. Conclusion: Penetrating canaloplasty in PACG appeared to have good efficacy and safety profiles in this pilot study. Further studies are justified.

Importance Under‐detection and late diagnosis are major causes of glaucoma‐related visual impairment. Cost‐effective opportunistic glaucoma screening is of great interest in the early identification and prevention of glaucoma. Background To describe the results of a health examination centre‐based opportunistic glaucoma screening and referral model. Design This single centre cross‐sectional study was conducted in a health examination centre affiliated to a tertiary hospital in Shenyang, northeastern China. Participants From 21 March to 30 September 2016, 14 367 individuals aged ≥ 30 years undergoing routine physical examinations were invited for this glaucoma screening. Methods Presenting visual acuity, non‐contact pneumotonometry and non‐mydriatic fundus photography were evaluated. Fundus photographs were classified as non‐glaucoma, possible, probable and definitive glaucoma. Participants with probable and definite glaucomatous discs or intraocular pressure ≥ 24 mmHg were referred for definitive examinations. Main Outcome Measures Detection rate of glaucoma suspects and ocular hypertension (OHT). Cost to identify a single case with suspected and diagnosed glaucoma was also calculated. Results Altogether, 277 glaucoma suspects and 327 ocular hypertension suspects were identified. Among 190 participants with probable/definite glaucomatous discs, 93 (48.9%) accepted further examination. Among these, 78 were diagnosed as glaucoma, seven as suspects and eight were excluded. Only 98 ocular hypertension suspects (30.0%) accepted further examinations: eight had primary angle closure and 23 had confirmed ocular hypertension. The cost to identify a single glaucoma suspect and definite glaucoma case were US$135 and US$857, respectively. Conclusions and Relevance This novel screening model provides opportunities to improve glaucoma detection at low cost. Interventions to improve follow‐up are needed.